Regulation
When your pet is first diagnosed with diabetes, your goal is to "regulate" the pet's blood glucose, which may take a few weeks or even many months. This process is basically the same as in type-1 diabetic humans. The goal is to adjust insulin dose to keep the blood glucose values in a comfortable range for the pet during the whole day, or most of it. Regulated cats or dogs can "slip out" of regulation at any time because the body is not a static system. Mealtimes Cats and dogs may in some cases have their mealtimes strictly scheduled and planned to match with injection times. In other cases where the pet free-feeds and normally eats little bits all day or night, it may be best to remain on this schedule and try to use a very slow-acting insulin to keep a constant level of blood glucose. Consult your veterinarian. Insulin Note that some veterinarians still use the outdated recommendation of using Humulin N or NPH insulin for cats. This insulin is too fast-acting for most cats (though fine for dogs and humans). A cat's metabolism seems to go through insulin about twice as fast as a human's, and the often-effective slower-acting Lente and Ultralente (Humulin L and Humulin U) insulins are being discontinued (as of 2005), so most cats are now using either the veterinary PZI insulins, or the new full-day analogs glargine (Lantus) and detemir (Levemir). Method The recommended method is to Start Low-Go SlowStart Low - Go SlowDr. Ian Blumer's Practical Guide to Diabetes An MD who advises his human patients to Start Low and Go Slow.Dr. Blumer's Letter to Newly-Diagnosed Human Diabetics in His Practice: # Have an initial blood glucose reading, perhaps even a curve, taken at the vet's and receive an initial dosage recommendation. You also could do a curve at home with a glucometer. Hometesting blood glucose levels just before each shot and at midpoint is essential -- it will save many expensive trips to the vet, avoid dangerous overdoses, and give you a better handle on your pet's ongoing condition. Urine testing stix are not accurate enough for this. # The initial dosage should be very conservative (low) (usually between 0.5 and 1 unit twice a day, every 12 hours) and may or may not affect the pet's symptoms noticeably at first. This is necessary because although high blood sugar can kill within weeks, low blood sugar can kill in minutes. Dosage must be increased gradually and carefully. The usual recommended method is to increase the dose by 1/2 to 1 unit every 7 to 14 days, followed by further blood glucose testing. An initial decrease may also be necessary ''--it is unfortunately fairly common for the initial recommendation to be a little bit too high, especially if it was estimated by weight. A decrease also would be needed if your pet experiences an episodic or chronic somogyi rebound. # Your pet is "regulated" when its blood glucose remains within an acceptable range all day, every day. Acceptable levels vary somewhat between cats, dogs, and vets, but is roughly from 5 to 16.7 mmol/L (90 to 300 mg/mL in the USA) for cats, and between 5 and 10 mmol/L (90 to 180 mg/dL)Beyond Insulin Therapy: Achieving Optimal Control in Diabetic Dogs-Drs. Fleeman & Rand- U. Queensland 2005 for dogs. (The range is wider for diabetic animals than non-diabetic, because shots cannot replicate the accuracy of a working pancreas.) '''It's important, though, that the glucose level be in the lower half of that range for as much of the day as possible.' If you are not testing blood glucose levels at home, some vets recommend that you stop increasing the dosage when the dog or cat is drinking normally, urinating normally, and eating normally, although organ damage may continue in some cases until glucose is below the renal threshold -- testing urine with keto/glucostix will show when this has been achieved. # If after a few weeks of this procedure, your pet's blood glucose level is still high, continue on to read about obstacles to regulation and curves. Tighter control in cats Dr. E. Hodgkins, Dr. J. Rand, and lately some others are now advocating Rand and Marshall: Understanding Feline Diabetes Mellitus: Pathogenesis and ManagementDr. Elizabeth Hodgkins: Protocol for feline diabetes treatment tighter control of blood glucose level in cats, starting as soon as possible after diagnosis. They believe that tight regulation leads to a fast remission of diabetic symptoms, and reduction of complications if begun quickly enough. The risk of hypoglycemia is balanced against the benefit of quick remission. See Tight regulation for some tested protocols that can achieve this goal in cats. in dogs All dogs will definitely benefit from tight control of blood glucose level, as it prevents long-term complications of diabetes, such as neuropathy,kidney damage, and blindnessIntervet-Guidelines for Successful Diabetes Management-Page 3Caninsulin Glossary-Complications. Remaining above Renal threshold of 180 mg/dl or 10 mmol/lCaninsulin Glossary-Renal Threshold can cause permanent blindness in dogs as well as other bodily complications. Further Reading *Rand & Marshall: Understanding Feline Diabetes Mellitus: Pathogenesis and Management *The FDMB FAQ on regulation *Beyond Insulin Therapy: Achieving Optimal Control in Diabetic Dogs-drs. Fleeman & Rand--U. Queensland 2005 *The "German" tight regulation protocol for cats using [[Lantus] or Levemir ] References Category:IntroductionCategory:RegulationCategory:Treatments